The small, triangular waiting room in the Fermathe dentistry clinic is simple, unadorned. It’s lined with pew-like wood benches, which is apt, as the clinic is part of the towering stone Baptist Mission in the mountains southeast of Port-au-Prince.

The only things on the whitewashed walls are a poster of a smiling mouthful of teeth and the menu of services:

Consultation: 50 gourdes

Pulling out a tooth: 100 gourdes

Fixing a front tooth: 350 gourdes

Fixing a back tooth: 350 gourdes

Cleaning: 300 gourdes

Lovely Avelus sits on her mother’s lap in an empty back pew, wearing her red tartan school uniform and clutching a scrap of paper with the number 18 scrawled on it. The number was obtained at 8:30 a.m., a half-hour before the clinic opened. Even then, the room resembled a Toronto subway car in rush hour, 50 people shoulder to shoulder. It’s now 1:30 p.m. and we are among the stragglers.

Every 10 minutes or so, the white-paneled door flies open, emitting a person moving at a clip, hand over mouth, or the towering, wild-haired receptionist.

If you don’t have a number, get lost, he barks. “Come back Tuesday at 6:30 a.m.”

He has worked here for more than a half-century, and is missing a number of front teeth.

Finally, he calls number 18, and mother Rosemene carries Lovely into a wide room, where two dentists are seated side-by-side working on patients. We join a gallery of onlookers standing against the wall to wait our turn. That gives us front row seats to watch one dentist — a large man, green gown askew — reaching forceps into the mouth of his patient and, yank, pulling out a tooth. He then tosses it into the garbage.

Twice.

Dentistry in Haiti is not for those with weak stomachs.

A 2005 study in Haiti revealed that roughly 40 per cent of 1,218 12- and 15-year-old dental patients had cavities, but of all those cavities there were only nine fillings.

“There are no operations, no fillings. In most public clinics there’s just extractions,” explains Dr. Samuel Prophète, vice dean of research at the State University of Haiti’s dentistry school and one of the study’s authors.

The Fermathe clinic is a public clinic. It is well-equipped, compared to one in the teeming La Piste refugee camp near the Port-au-Prince airport that I visited. There is no X-ray equipment or an assistant armed with a saliva vacuum, but it has a floor, a sink, adjustable dental lights and motorized scalers that spray water into your mouth. The clapboard hut on the edge of La Piste had only a chair, a plastic tub for used forceps and a garbage pail for teeth.

At the root of all this tooth-pulling is that menu of prices by the white paneled door. A filling at a public clinic costs about $8.75 — more than three times the cost of ripping it out. Most Haitians, who earn less than $2 a day, choose food over a beautiful smile.

Prophète says the government’s system of public clinics has been underfunded for years. They are woefully underequipped. Rural Haitians often have to travel hours by tap-tap to see a dentist. There are no frills and no drills — just forceps.

Nor are there many private clinics. The country’s single dentistry school graduates only 20 students a year. About half leave the country, Prophète says, for the United States or Canada. (Haiti’s consul general in Toronto, Eric Pierre, is one.) As result, there are fewer dentists in Haiti per capita than anywhere in the Western Hemisphere. Across the border in the Dominican Republic there are 21 times the dentists for every mouth.

It’s nearly impossible to get a start-up loan from a Haitian bank, so the dentists left behind buy equipment piecemeal — this year a chair, next year a saliva ejector. “By then, they might be comfortable and not want to invest in those things,” Prophète says.

“We don’t have the services here. There’s a standard, but nobody is there to enforce it.”

Haitians, as a rule, don’t visit the dentist for a regular check-up. They treat dental clinics like hospital ERs — arriving once the pain is unbearable. By then, extraction is the only option; root canals are practically unheard of.

Last November, Prophète and two others presented a national dental plan to the Ministry of Health. It called for a tooth-brushing campaign, properly equipped dental clinics in a least all 10 provincial public hospitals, the fluoridization of table salt and a chief national dentist. The ministry’s chief of staff was about to approve it, Prophète says. Then, on Jan. 12, the world collapsed.

Now, there are even fewer dentists in Haiti.

In the months after the earthquake, hundreds of first aid groups arrived. Most came to set bones, not to fix dental bridges. Toronto’s Galina Mohebat was one of the oddities. She is preparing for her third trip to Port-au-Prince this month. On her first trip, in March, the Canadian dentist treated 170 patients in four days.

“We saw literally two groups of people: extremely healthy teeth, no cavities, gums fine,” Mohebat says. “Another group, their teeth were a disaster — plaque, lots of teeth infected, black cavities. These were problems that had nothing to do with the earthquake. They’d been there for years.”

Three-year-old Lovely’s teeth fall squarely into this second category.

A brown line arcs across her upper front four teeth. Two look like they’ve been yanked out and stuffed back in upside-down. They are crescent-shaped instead of rectangular. Dark brown holes mark two molars in the back of her mouth. One got infected recently, swelling her cheek like a balloon. She spiked a fever and was in so much pain, she missed five days of school.

When it’s her turn to sit in the chair, dentist Jean-Marie Duverger digs into the back cavities with a wooden tongue depressor.

“See this,” he says to Rosemene. “This is very bad.”

I’ve shown a picture of Lovely’s teeth to many dentists, both in Haiti and back in Toronto. Theories range from baby bottle syndrome — teeth marinating in sugary milk or juice sipped at night — to a fever Rosemene might have had while pregnant. There’s also the sugar cane Lovely eats enthusiastically. Before the earthquake, her father sold the sweet snack, wheeling the plants along the streets of downtown Port-au-Prince.

But Duverger has a different theory. He’s been a dentist for 20 years — both here, serving poor farming families, and at his private clinic in the city, which was destroyed in the quake. He’s seen this “many times before.” It stems from in utero malnutrition.

“It depends on the health of the mother during pregnancy. If she didn’t eat a lot of vitamins and minerals, this happens,” he says. Lovely’s developing body didn’t have enough calcium to build strong teeth.

Her adult teeth will be fine, as long as she brushes regularly, Duverger says. Rosemene says she has a toothbrush, but I’ve never seen her use it. I vow to bring her one next time I climb the mountain for a visit.

Duverger writes up a bill. We don’t want to pull the teeth, thank you. To fix all four teeth costs 2,050 gourdes — about $51 Cdn. That’s just under half what Lovely’s family paid to rent their small one-room apartment for a whole year, before it collapsed on Jan. 12. In a private clinic, it would have cost about $200 Cdn.

The Star pays the bill, and we agree to come back next week for her first filling.